Justifying Rehabilitation Intensity Through Functional Performance Measures in Postacute Care

Area of Science:

• Rehabilitation Medicine
• Health Services Research
• Gerontology

Background:

• The Centers for Medicare and Medicaid Services (CMS) is examining rehabilitation services in skilled nursing facilities (SNFs).
• Limited research exists on appropriate rehabilitation intensity (RI) for patients in SNFs and other postacute care (PAC) settings.
• The CMS developed the Continuity Assessment Record and Evaluation (CARE) Tool to address questions about PAC placement drivers.

Purpose of the Study:

• To highlight the need for research on rehabilitation intensity (RI) in postacute care (PAC) settings.
• To evaluate the potential of the CARE Tool in assessing functional outcomes and correlating them with RI.
• To advocate for improved access to occupational therapy (OT) and physical therapy (PT) in SNFs and PAC settings.

Main Methods:

• Review of existing literature and policy regarding rehabilitation services in SNFs and PAC settings.
• Analysis of the capabilities of the CMS CARE Tool for functional outcome assessment.
• Discussion of the implications for policy, practice, and future research.

Main Results:

• There is a lack of established guidance on optimal rehabilitation intensity (RI) for SNF and PAC patients.
• The CARE Tool offers a promising method for assessing functional outcomes and their relationship to RI.
• Further research, policy advocacy, and practice analysis are necessary to ensure adequate access to therapy services.

Conclusions:

• Continued scrutiny of rehabilitation services in SNFs by CMS necessitates further investigation into RI.
• The CARE Tool has the potential to inform practice and policy, but requires further validation and utilization.
• Active participation of individual practitioners in data gathering is crucial for informed analysis and advocacy, particularly from the occupational therapy perspective.